Provider Demographics
NPI:1275937757
Name:GEORGE DAMERJI DDS PC
Entity Type:Organization
Organization Name:GEORGE DAMERJI DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:DAMERJI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-235-0000
Mailing Address - Street 1:3939 W FULLERTON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-2243
Mailing Address - Country:US
Mailing Address - Phone:773-235-0000
Mailing Address - Fax:773-235-0001
Practice Address - Street 1:3939 W FULLERTON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-2243
Practice Address - Country:US
Practice Address - Phone:773-235-0000
Practice Address - Fax:773-235-0001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-13
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019028287122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty